THINK-TANK They can now charge as much as they think they can squeeze out of patients. Charges tend to vary, depending on the Medical care is patients’ addresses, whether they have medical insurance policies or are dressed expensively or wear jewellery. Foreign patients are more likely to be overcharged because they have no time to shop around. I know first-hand of an Indone- sian patient who was charged $100,000 not a commodity for a simple laparoscopic removal of a gall bladder, a procedure that usually costs $10,000 in the private sector. There have been enough cases of shameless profiteering to earn some private hospi- tals here a bad reputation. Public-sector doctors cannot over- charge because their fees are fixed by the BY LEE WEI LING M Ministry of Health. Many of us in the pub- lic sector have had friends, both local and OST developed countries foreign, ask us for advice about which believe that the free market doctors in the private sector they should is the best system for consult. They know that without medical allocating scarce commodi- information, they are unable to tell which ties. The right price for are the good doctors, professionally as such commodities, they believe, is best well as ethically. determined by allowing the forces of sup- The current situation, with some ply and demand to operate freely. specialists in the private sector overcharg- But a free market can work efficiently ing, is bad for Singapore. The Govern- only if sellers and buyers have roughly ment hopes to promote medical tourism. equal knowledge about the commodities But news of overcharging spreads very changing hands. Such a condition does quickly abroad. Unless action is taken not always exist. Medical care, especially, soon, greed will kill the goose of medical cannot be priced like any other commodi- tourism before it has had a chance to lay ty because the seller (the doctor) has any egg, let alone golden ones. much more information than the buyer Overcharging is also bad for Singa- (the patient). pore’s medical fraternity. Young doctors The patient is therefore at the mercy watch what their seniors do and will over- of the doctor, not only in terms of what charge too when they enter private prac- he is charged but also in terms of what he tice. As it is, there is already an erosion of needs to “buy”. For example, procedures medical ethics here – not only because of overcharging, but also because of super- that may be unnecessary, such as blood fluous referrals to other specialists who tests and radiological examinations, may are one’s personal friends, unnecessary be ordered by a doctor, and the patient and expensive investigations and even would be in no position to refuse. some unnecessary procedures that carry One could argue, of course, that risk of harm to patients. patients can shop around to find doctors Medicine as a profession is a calling, who would offer them the cheapest pack- and medical care cannot be treated as a age. But this is impractical: Patients with mere commodity. If the medical fraterni- urgent medical problems do not have ty does not act soon to cajole or coerce time to shop around. Patients from for- fees for various medical procedures. It In such cases, the SMA would request consumers from being overcharged by the black sheep among us to stop taking eign countries would want to get their was only a guideline, so doctors could de- the relevant doctor to justify the extra allowing free-market forces to determine advantage of patients, Singapore’s reputa- medical problems attended to quickly so viate from the quoted fees if they wished. charge, and if there was no reasonable prices. And the GOF was designed precise- tion will suffer and all its doctors will be that they can return home. Moreover, pa- However, if they did so, they were expect- explanation, it would advise the doctor to ly to protect patients from being over- tarred by the same brush. If we delay tients are usually informed of the medical ed to inform patients in advance. refund the difference. This advice was charged by private medical specialists – reforming the system, its faults will This enabled patients to know what also transmitted to the patient who com- always a possibility given the asymmetry procedures they require only after consul- become more difficult to reverse. was the “premium” they were expected plained. Most doctors who overcharged of information between doctors and tation with a doctor. They do not know Reviving the GOF would provide one to pay for the exceptionally superior treat- without good reason followed the SMA’s patients. beforehand what they would require in solution to the problem of overcharging. To abandon the GOF on the grounds order to shop around effectively. This, ment their doctors were promising, and advice and refunded the money. The It is not a perfect solution but, as with that it is anti-competitive is so illogical together with the time constraint, makes they could decide for themselves whether guideline worked, functioning both as a that I wonder whether anyone in the many other problems in life, there is no it impossible for most patients to make they wished to pay that premium. moral and practical rubric. Competition Commission of Singapore perfect solution. We know that the GOF an informed choice among doctors. Sometimes, patients discovered they In 2006, the SMA abandoned the GOF understood that medical fees cannot be will work – because it did. Prior to 2006, the Singapore Medical were charged much more than what was because it was encouraged to believe that determined by free-market forces. The The writer is Director of the National Association (SMA) had a “Guidelines on recommended in the GOF only after they the guidelines might contravene the Com- abandonment of the GOF has made Neuroscience Institute. Think-Tank is a weekly Fees” (GOF) for doctors in private prac- received their bills. Some complained to petition Act. Ironically, the purpose of patients the easy prey of unscrupulous column rotated among eight leading figures in tice. The GOF recommended a range of the SMA as a result. the Competition Act was to protect private specialists. Singapore’s research and tertiary institutions.